Adult Consequences of Spina Bifida: A Cohort Study

• Published in: Clinical orthopaedics and related research 2011-05, Vol.469 (5), p.1246-1252
• Main Authors: Roach, James W., Short, Barbara F., Saltzman, Hanna M.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adult; Age; Amputation; Cause of Death; Cerebrospinal Fluid Shunts; Cognition; Cognitive ability; Cohort Studies; Conservative Orthopedics; Disability Evaluation; Educational Status; Employment; Foot; Hip; Humans; Independent Living; Intelligence; Intelligence Tests; Medicine; Medicine & Public Health; Meningomyelocele - diagnosis; Meningomyelocele - mortality; Meningomyelocele - physiopathology; Meningomyelocele - psychology; Meningomyelocele - surgery; Middle Aged; Neurosurgery; Orthopedics; Pediatrics; Pressure; Progeny; Recovery of Function; Retrospective Studies; Shunts; Social Behavior; Social interactions; Social Isolation; Spina bifida; Spinal Dysraphism - diagnosis; Spinal Dysraphism - mortality; Spinal Dysraphism - physiopathology; Spinal Dysraphism - psychology; Spinal Dysraphism - surgery; Sports Medicine; Surgery; Surgical Orthopedics; Surveys and Questionnaires; Symposium: Myelomeningocele; Texas; Thorax; Treatment Outcome; Urination; Young Adult
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-010-1594-z

Background Patients with spina bifida potentially experience social isolation with limited employment opportunities and restriction of independent living, neurologic and intellectual impairment, and orthopaedic and urologic consequences of their condition. However, the degree of disability as these individuals age into adulthood has not been completely delineated. Questions/purpose In adults with spina bifida we determined the cause of death for those who had died, IQ, level of education, work history, independent living status, physical disabilities, and urologic status; we then identified surgical procedures that led to better adult function. Methods We retrospectively reviewed 84 individuals with myelomeningocele, examining social, cognitive, and physical disabilities. The minimum age at followup was 20 years (mean, 31 years; range, 20–64 years). Results Forty-two percent had normal IQs. Seventy percent never needed a neurosurgical shunt and those without shunts had higher IQs. Forty-four percent had regular education and 8% achieved college degrees. Fifty-six percent were unemployed. Thirty percent lived independently. Twenty-three percent were either married or divorced with nine normal offspring. Eighty-five percent dressed themselves, 65% shopped independently, 54% drove. Thirty-one percent were at the thoracic neurologic level (all used wheelchairs), 12% were at L1–L3 (all used a wheelchair except one), 33% were at L4–L5 (78% used a wheelchair at least part-time), and 24% were at S1 and below (all walked). Fifty-four percent experienced decubiti and as a consequence, four required major extremity amputations. Spinal fusions protected sitting balance, but hip surgery did not produce congruent hips and occasionally resulted in debilitating stiffness. Pressure sores resulted in partial foot amputations despite plantigrade feet. Conclusions Our observations confirm the consequences associated with the physical and cognitive disabilities of patients with spina bifida. Many of these consequences can likely be mitigated by modern multidisciplinary care and special education to increase independence. Level of Evidence Level IV, observational study. See Guidelines for Authors for a complete description of levels of evidence.